Please enable JavaScript in your browser to complete this form.CREDIT REFERENCE REQUESTPlease email Christine Basilio with any questions: christine@jcsmithinc.comInquiring Business:Date:Phone:Contact Name:Email:Represented Company:Represented Address:Specific Request:*Our team will complete the bottom portion of this form and send it back. Contact Represented company: Number of years with your company:Credit Terms:Over 60 DaysOver 90 daysOpen Balance:Payment History:PromptSlowLateSignature:Date:Submit